Healthcare Provider Details

I. General information

NPI: 1376189712
Provider Name (Legal Business Name): JOANNE DAGONESE MS IN SPECIAL ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32500 RIVERSIDE DR # H4
LAKE ELSINORE CA
92530-7885
US

IV. Provider business mailing address

32500 RIVERSIDE DR # H4
LAKE ELSINORE CA
92530-7885
US

V. Phone/Fax

Practice location:
  • Phone: 951-609-5678
  • Fax:
Mailing address:
  • Phone: 951-609-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: